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Clinical Case Reports

ISSN: 2165-7920

Open Access

Current Issue

Volume 11, Issue 3 (2021)

    Short Communication Pages: 1 - 2

    A Single Centre Based Study on Prevalence of Left Ventricular Dysfunction in End Stage Renal Disease Patients on Peritoneal Dialysis

    Dr. Richu Sharma1* and Shivali Sharma2

    Heart failure affects more than 40 million people globally in a single year and is expected to increase in the coming time. In patients, who have associated comorbidities are more likely to develop left ventricular dysfunction and subsequently heart failure. Left ventricular dysfunction increases cardiovascular mortality and morbidity in end stage renal disease patients on hemodialysis. Peritoneal dialysis has emerged as an alternative mode of renal replacement therapy for end stage renal disease patients. However the prevalence of left ventricular dysfunction in end stage renal disease patients is scarcely known. A 33.33% prevalence of left ventricular dysfunction has been observed in our study.

    Case Report Pages: 1 - 3

    Impact of Graded Early Mobilization Therapy on Psychomotor status of a Patient who was Mechanical Ventilated in Intensive Care Unit: A Single Case Report

    Bijoy Das

    The purpose of the study was to explore the impact of graded early mobilization on psychomotor status of patients with mechanical ventilation. To measure the effect of early mobilization on days first out of bed, other motor function, psychological status and length of ICU stay of mechanically ventilated patient. This was a single case study. Sample was selected from BRB Hospitals Limited of Dhaka using convenient sampling method and according to selection criteria. A precise semi structured questionnaire was used for data collection. Graded early Mobilization was provided as intervention to the participant by a Professional qualified Physiotherapist for 10 sessions. Another Senior Physiotherapist was assigned as data collector. He assessed the participant’s Functional Independence Measure (FIM) score and Generalized Anxiety Disorder 7 point (GAD-7) score during discharge from ICU. It was found that Functional Independence Measure (FIM) score was 65 which means the participant was very much independent during discharge from ICU. The finding of GAD-7 was 04, which indicates that the participant was free from any psychological problems. This study showed that graded early mobilization was effective to improve mechanically ventilated patients motor and psychological status.

    Case Report Pages: 1 - 2

    Purpura Fulminans in a 9-Year-Old Boy with Auto-Amputation of Digits: A Case Report

    Naheed Maqbool, Rabbia Khurshid, Saleem Ullah Khan and Noor Us Sabah

    Purpura fulminans may have infectious, hereditary and idiopathic etiology. We came across a case of purpura fulminans in a 9-year-old boy who had been healthy for first 4 years of his life and suddenly developed gangrenous lesions on extremities which proceeded to the detachment of some digits. Laboratory evaluation revealed mild anemia, hypoalbuminemia, high platelet count, elevated aPTT, PT and INR, mild proteinuria and high urinary protein to creatinine ratio. Child was managed by warfarin therapy

    Case Report Pages: 1 - 5

    Research Progress of Novel Coronavirus Pneumonia Vaccine

    Song Peng

    Since novel coronavirus pneumonia (novel coronavirus pneumonia) novel coronavirus outbreak, countries around the world have accelerated the development of a new coronavirus pneumonia vaccine (new crown vaccine). As of December 2020, 60 candidate new coronal vaccines have been approved for clinical trials, among which 7 vaccines (3 inactivated vaccines, 2 mRNA nucleic acid vaccines, and 2 vector vaccines) have been approved for emergency use or conditional marketing. In this paper, the development progress, advantages, and disadvantages of six new coronal vaccines including inactivated vaccine, nucleic acid vaccine, vector vaccine, protein subunit vaccine, live attenuated vaccine and virus-like particle vaccine was reviewed. The results of the novel coronavirus pneumonia in phase III clinical trials show that the new vaccine has good safety and immunogenicity. The approved vaccine has been proved to have good protective efficacy. However, attention should be paid to the adverse reactions of the vaccine and the long-term protective effect.

    Case Report Pages: 1 - 2

    Mixed Adenoneuroendocrine Carcinoma of the Perianal Region: A Case Report

    Jelena Berendika, Gordan Nikic, Dejan Dokanovic, Milka Vjestica, Sanja Savic, Sasa Jungic, Zdenka Gojkovic, Bozana Babic and Biljana Tubic

    Paraganglioma is a very rare extra adrenal nonepithelial tumor. The number of cases of laparoscopic surgery in Paraganglioma is small and controversial. This study encountered a case of successful transperitoneal laparoscopic surgery for a 56 mm paraganglioma in a 53-year-old female. Moreover, previous reports on laparoscopic surgery for paraganglioma are reviewed.

    Case Report Pages: 1 - 6

    A Patient with Paraganglioma Undergoing Laparoscopic Resection: A Case Report

    Hisamichi Yoshii, Hideki Izumi, Takuma Tajiri, Masaya Mukai, Eiji Nomura and Hiroyasu Makuuchi

    Paraganglioma is a very rare extra adrenal nonepithelial tumor. The number of cases of laparoscopic surgery in Paraganglioma is small and controversial. This study encountered a case of successful transperitoneal laparoscopic surgery for a 56 mm paraganglioma in a 53-year-old female. Moreover, previous reports on laparoscopic surgery for paraganglioma are reviewed

    Case Report Pages: 1 - 3

    Alignment of Buccally Erupted Canine Using HANT Wire

    Parijat Chakraborty, Kamlesh Singh, Ragni Tandon, Richa Dhingra and Pranshu Mathur

    Ectopic teeth develop when displaced from their normal position. Any permanent tooth can be ectopic, and the cause may be both genetic and environmental. Orthodontic treatment is justifiable for aesthetic reasons. Subsequently a careful diagnosis along with a proper treatment plan for ectopically erupting permanent maxillary canines requires timely management by the orthodontist. The purpose of this case report is to illustrate an approach involving management using HANT wire.

    Case Report Pages: 1 - 2

    Severe COVID-19 with 32 Weeks of Pregnancy Treated by Convalescent Plasma: A Case Report

    Ashraful Hoque

    Pregnant women with coronavirus disease 2019 (COVID-19) show overall similar clinical features as that of non-pregnant adults with COVID-19, except perhaps for higher risk of admission to the Intensive Care Unit (ICU) and mechanical ventilation. Apart from the established therapeutic options used in COVID-19 like steroid, low molecular weight heparin role of COVID Convalescent Plasma (CCP) has never been evaluated. We present a case of a pregnant woman, treated with CP at the AMZ hospital, Dhaka, Bangladesh.

    Case Report Pages: 1 - 2

    Thyrotoxic Hypokalemic Periodic Paralysis: A Case Report

    Ketlin Batista de Morais Mendes, Cristhenise Ragnini Silva, Bárbara Silvestre Vicentim, Thaís Rockenbach Gaona Lenzi, Gabriela Moreira Ferle, Vanessa Almeida Santos, Wülgner Farias da Silva, André Nazário de Oliveira and Antonio Solon Mendes Pereira

    Periodic Thyrotoxic Hypokalemic Paralysis (PTHP) is a rare endocrinological complication characterized by hypokalemia, episodes of muscle weakness and thyrotoxic symptoms. The following is a case report of PHHP in a black patient diagnosed with hyperthyroidism during an episode of sudden and progressive weakness associated with hypokalemia. PHHP is often underdiagnosed and should be remembered as a diagnosis of acute muscle weakness in young patients, especially males, regardless of ethnicity, although it is frequent in Asians.

    Case Report Pages: 1 - 3

    A Case Report of Aortic Dissection in A Uremic Hemodialysis Patient

    Zhi Xiao, Binbin Wang and Yanyu Li

    Aortic dissection is a critical cardiovascular disease with extremely high mortality. It has an acute onset and poor prognosis. Patients with uremic hemodialysis have more risk factors for aortic dissection than ordinary patients. Early diagnosis and treatment have a positive impact on the prognosis of aortic dissection. This article reports a case of uremic hemodialysis complicated with aortic dissection, aiming to further explore the clinical diagnosis, treatment and distinguishing characteristics of uremic complicated with aortic dissection, and improve the early diagnosis rate of the disease.

    Review Pages: 1 - 7

    Recurrent Venous Thrombosis and Breakthrough Thrombosis: A Narrative Review

    Rasha A. Al-Khafaji

    Venous Thromboembolism (VTE) is a vexing heterogeneous disease that, along with Myocardial Infarction (MI) and stroke, is among the top three cardiovascular killers. VTE's morbidity and mortality globally cause high social, health, and economic impacts. The modern diagnostic strategies of Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) developed to aid physicians in diagnosing these presentations and using imaging resources effectively have shown limitations in several subgroups, including patients with recurrent VTE or those who are already on anticoagulation therapy. In the light of a previously reported breakthrough (recurrent) DVT while on rivaroxaban 20 mg PO daily in a 43-year-old Caucasian female, this review discusses the various etiologies, which contribute to anticoagulant's failure and VTE's recurrences in general to increase awareness among practicing physicians about these subgroups. The roles of imaging and D-dimer testing in these subgroups are also discussed, leading the author to cautiously conclude that diagnostic imaging plays a central role in identifying recurrence regardless of D-dimer testing and recommending baseline sonography upon completing DVT anticoagulation therapy for future references. Accurate diagnostic strategies are needed to ensure the best available care and treatment reaches the patient. Based on this review, the author constructs a hypothetical algorithm targeted to diagnose recurrent VTE or breakthrough VTE while on anticoagulants coupled with the possible causes for recurrent and breakthrough VTE. This algorithm should only be considered as hypothesis-generating for specifically designed prospective studies to assess and validate the algorithm's potential in decreasing the incidence of missed diagnosis of VTE and their underlying etiologies in these subgroups.

    Case Report Pages: 1 - 2

    A Curious Case of Hypertensive Emergency and Acute Kidney Injury

    Oluwaseun Oluwo, Dennis Hu, Ashkan Karimi, Garland Campbell and Negiin Pourafshar

    A 75-year-old female with history of a prior right renal artery stent (coronary bare metal stent, duration 3 years), stage IV CKD (baseline serum creatinine (Scr) 2.1-2.3 mg/dL (eGFR 20-23 ml/min/1.73 m2 )), diastolic heart failure, and hypertension. She had multiple hospital admissions for acute decompensated heart failure, now presenting with worsening dyspnea, increased oxygen requirements of 4 L oxygen via nasal canula, increased from baseline 2 L. Despite treatment with up to nine anti-hypertensive medications, her systolic BP remained 180-200 mmHg. Her Scr also increased to 3.92. Work-up showed normal kidney sizes and urine protein/creatinine ratio 1.26 g/g. Renal artery duplex revealed right renal artery peak systolic velocity 267 cm/sec, renal-to-aortic ratio 2.68, and resistive index 0.7-0.9, suggestive of right renal artery re-stenosis and some intrinsic damage. Due to progressive volume overload and worsening respiratory status, she required temporary hemodialysis. As her volume status improved, she underwent CO2 angiogram and was found to have 90% diffuse in-stent restenosis with marked deformity of the previous stent. She underwent re-stenting of the right renal artery with a proprietary FDA-approved Herculink Elite® renal stent with only 8 ml of contrast. Immediately post-intervention, her BP dramatically improved and after two months, hemodialysis was stopped, (new baseline SCr 1.5-1.9) and she only required two BP medications.

    Case Reports Pages: 1 - 3

    Acute Kidney Injury Related to Muscle Breakdown-Not All Due to Rhabdomyolysis: A Case of Acute Urate Nephropathy

    Oluwaseun Oluwo, Anita Vincent-Johnson and Kambiz Kalantari

    A young man with a history of pseudo-seizures was admitted after an episode of severe agitation and rigorous physical activity. The patient was febrile on admission with notable leukocytosis and lactic acidosis but a negative infectious workup. During the hospitalization, the patient developed severe Acute Kidney Injury (AKI) despite fluid hydration. Creatinine Phosphoryl Kinase (CPK) was minimally elevated at 693 U/l. Urine microscopy was significant for many uric acid crystals. Subsequent lab studies revealed an elevated uric acid level of 13.4 mg/dl with fractional excretion of urate (Fe-Urate) of 13%. The patient was treated with rasburicase and allopurinol with the improvement of AKI that paralleled the improvement in hyperuricemia. AKI was likely due to acute urate nephropathy from a pseudo-seizure. AKI following an icteric activity or rigorous physical activity can occur via a mechanism that is independent of rhabdomyolysis. Acute Urate Nephropathy should be considered in cases with no significant elevations of CPK, with prompt initiation of rasburicase and potentially rapid resolution of AKI.

    Case Report Pages: 1 - 3

    Thinking of Rare Bleeding Disorders in the Emergency Room: A Diagnosis of Glanzmann Thrombasthenia in a Pakistani Child

    Salma Mainosh, Ayesha Akbar Khalid, Mushtaq Ahmed and Syeda Shaheera Hashmi Riaz

    Introduction: Glanzmann thrombasthenia is a rare inherited bleeding disorder, with a global prevalence of about one in one million. It is an autosomal recessive condition characterised by episodes of mucocutaneous bleeding. A defect in the membrane protein results in a defective platelet aggregation. Case presentation: A fifteen-month-old female child presented to the emergency department with nosebleed for the last two days. The patient had two similar episodes of epistaxis in previous few months which were managed at home. There was an accompanying complaint of easy bruising since birth. After emergency management and anterior nasal packing, extensive blood tests were ordered to determine the cause for recurrent haemorrhages. Platelet aggregation study concluded a diagnosis of Glanzmann thrombasthenia and the patient was treated accordingly. Family members were thoroughly counselled, and safety netting was vigilantly done. Conclusion: Many public tertiary cares set ups in Pakistan lack the adequate diagnostic and therapeutic facilities for bleeding disorders. This does not only result in delaying appropriate care but also causes patients to remain undetected. Through this report, we aim to encourage emergency physicians to have a high index of suspicion for haematological disorders in patients presenting early in life with recurrent bleeding episodes.

    Case Report Pages: 1 - 4

    Balancing Sleep and Motor Symptoms: A Case Report of Managing Insomnia in Parkinson???s Disease

    Meghan Ha, Nishita S. Amin, Katie Meyers, Jacques Turgeon and Chandni Bardolia

    Objective: The management of insomnia presents as a challenge for many Parkinson’s disease patients and their care teams. Insomnia in patients with Parkinson’s disease may be attributed to the side effect profile of several medications that are commonly used to treat Parkinson’s disease. Additionally, the progression of the disease is associated with disruption of circadian rhythms, nocturnal symptoms, blunted melatonin secretion, and late melatonin onset. This case aims to demonstrate how a patient’s medication profile, which included several Parkinson’s disease medications, could be optimized to control motor symptoms and reduce the occurrence of insomnia through the use of comprehensive medication review services. Case report: A 71-year-old male with Parkinson’s disease was developing severe symptoms of tardive dyskinesia due to his chronic carbidopa/ levodopa/entacapone therapy. In order to address the tardive dyskinesia, entacapone was discontinued and amantadine was initiated to offset the stiffness and bradykinesia that he was experiencing. The addition of amantadine resulted in nightmares and poor sleep quality, even though he was already taking mirtazapine to treat his depressive status and insomnia. The patient’s healthcare team collaborated with a clinical pharmacist to adjust the Parkinson’s disease regimen and optimize mirtazapine dosage, all of which resulted in notable improvements in his reported insomnia and quality of life. Discussion and Conclusion: Optimizing motor control in patients with Parkinson’s disease, while mitigating insomnia side effects of medications, can be a very complex process. The main goal for patients who encounter this problem is to enhance their current Parkinson’s disease therapy by identifying medications that can contribute to insomnia and to optimize the regimen to address the patient’s symptoms and disease progression. Alternative treatments to manage insomnia in patients with Parkinson’s disease should also be considered, including the addition of melatonin and/or the use of bright light therapy

    Case Report Pages: 1 - 3

    Metastatic Disease to the Pancreas from Squamous Cell Lung Cancer: A Case Report

    Ivan Bivolarski

    We present a one clinical case of patient with metastasis of squamous cell non–small-cell lung cancer in pancreas. A 49-year-old Caucasian male patient presented to our Medical Oncology department with obstructive jaundice and severe abdominal pain, after the last course of chemotharapy. Six months prior to presentation the patient had undergone right bronchoscopy, due to stage IV, moderate-grade squamous cell lung carcinoma. After the bronchoscopy, the patient receives chemotherapy and radiotherapy. Abdominal computed tomography on admission after the last course of chemotharpy, revealed lesion located at the head of the pancreas, causing biliary obstruction. The abdominal computer tomography reveals also lesion in left adrenal gland. Histological examination reveals and changes in grade of the histology from moderate in primary foci in lung to low-grade in metastasis in pancreas. Due to the severe pain in the abdomen and jaudice of the metastatic disease, surgical resection was proposed and the patient underwent pancreaticoduodenectomy. Histological examination of the resected specimen from pancreas confirmed a low-grade squamous cell carcinoma form the lung.

    Case Report Pages: 1 - 3

    Fibroadenoma of the Breast in Identical Twin: A Case Report

    Marwa Badawi* and Ahmed Shalaby

    Fibroadenoma is a painless, unilateral, benign breast lesion that is a solid in consistency. It occurs most commonly in women between the age of 14 to 35 years but can be found at any age. This is a case report for a young twin who presented to the one stop clinic with a unilateral breast lump in the right upper quadrant of the breast. Both patients were assessed clinically by obtaining detailed history and clinical examination and further evaluation of the lump was done by ultrasound examination, which confirmed diagnosis and patients were reassured and treated conservatively.

    Case Report Pages: 1 - 2

    Papilledema and Diplopia Due to Meningioma Inside the Superior Sagital Sinus: Case Report and Review of the Literature

    Marta Rico Pereira* and Carlos Asencio Cortés

    Small lesions invading or compressing dural sinuses are frequent but secondary intracranial hypertension is not very common, with few examples reported in the literature. This event may be explained in the setting of anatomic variants in pattern of venous sinus circulation. We present the case of a patient who presented with papilledema and loss of visual acuity due to a small meningioma located inside the superior sagittal sinus (SSS). The patient underwent a lumboperitoneal shunt placement with recovery of symptoms. Literature available is also reviewed.

    Case Report Pages: 1 - 2

    Acute Pancreatitis-Rare Complication of Falciparum Malaria

    Satya Kant Tiwari* and Richa Patel

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    Case Report Pages: 1 - 5

    A Case Report of an Unusual Presentation of Melioidosis

    Phani Machiraju*, Rama Narasimhan, Kiran Kompella and Suresh Kumar D

    Melioidosis is a granulomatous infectious disease caused by Burkholderia pseudomallei. It is a motile, aerobic, oxidase-positive, gramnegative, non-spore forming soil saprophyte. It has gained a lot of importance in recent times as one of the most potent emerging infections in India. The clinical presentation of Melioidosis is highly variable, ranging from benign skin and soft tissue infections to rapidly fulminant and fatal septicaemia. It is because of this wide range of clinical diversity, it is called "Great mimicker" and poses diagnostic challenges to clinicians. In this case report, we illustrate the diagnostic difficulties we faced and our management of infrequent complication of disseminated Melioidosis presenting as broncho-oesophageal fistula with concomitant lung consolidation.

    Review Article Pages: 1 - 3

    Impact of Graded Early Mobilization Therapy on Psychomotor Status of a Patient Who was Mechanical Ventilated in Intensive Care Unit

    Bijoy Das, Sanchita Saha, Feroz Kabir, Sazzad Hossain

    Purpose: The purpose of the study was to explore the impact of graded early mobilization on psychomotor status of patients with mechanical ventilation.

    Objectives: To measure the effect of early mobilization on days first out of bed, other motor function, psychological status and length of ICU stay of mechanically ventilated patient.

    Methodology: This was a single case study. Sample was selected from BRB Hospitals Limited of Dhaka using convenient sampling method and according to selection criteria. A precise semi structured questionnaire was used for data collection. Graded early mobilization was provided as intervention to the participant by a Professional qualified physiotherapist for 10 sessions. Another senior physiotherapist was assigned as data collector. He assessed the participant’s Functional Independence Measure (FIM) score and Generalized Anxiety Disorder 7 point (GAD-7) score during discharge from ICU.

    Results: It was found that Functional Independence Measure (FIM) score was 65 which means the participant was very much independent during discharge from ICU. The finding of GAD-7 was 04, which indicates that the participant was free from any psychological problems. 

    Case Report Pages: 1 - 3

    Rare Gingival Metastasis by Pancreatic Carcinoma: A Case Report

    Gordana Zamolo

    Metastatic tumors to oral cavity are rare and represent approximately 1% off all cases of oral malignat lesions even though metastatic disease may be present. The 53-year-old female presented in March of 2017 complaining with abdominal pain, weight loss and loose stool not more than 3 times per day. CT scan of the abdomen in July showed retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with biopsy of mucosa of the stomach showed normal result. The tumor marker Ca 19-9 in July 2018 was 110.3 and in August 2018 350.6. The patient was referred in September of 2018 to the maxillofacial surgery Clinic for examination of the lesion in the oral cavity. She presented with a pain, swelling and occasional bleeding around the lower right second mollar. Immunohistochemical the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2) which is highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor in lower right gingiva and highlights the importance how immunohistochemical examination helped to identify both the origin and the nature of gingival neoplasm.

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